Provider Demographics
NPI:1487211264
Name:ABRAMS, KENNETH BRIAN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BRIAN
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTH COLLEGE ST
Mailing Address - Street 2:PSYCHOLOGY DEPARTMENT
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-222-5024
Mailing Address - Fax:507-222-7005
Practice Address - Street 1:706 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2427
Practice Address - Country:US
Practice Address - Phone:507-646-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical